Fellow in Heart Failure, Mechanical Circulatory Support & Heart Transplantatiom
Viability of native kidney in cardiorenal transplantation
Rosario della Cella Figueredo1, María F Renedo1, Daniel O Absi1,2, Elián F Giordanino1, Carolina B Putaro1, Liliana E Favaloro1, Roberto R Favaloro1,2, Hugo Fraguas2, Pablo Raffaele3, Rita M Fortunato3, Alejandro M Bertolotti1,2.
1Heart Failure, Mechanical Circulatory Support and Heart Transplantation, Fundación Favaloro, Buenos Aires, Argentina; 2Cardiovascular Surgery, Fundación Favaloro, Buenos Aires, Argentina; 3Renal Unit, Fundación Favaloro, Buenos Aires, Argentina
Introduction: Renal failure can be present in up to 50% of patients (P) with chronic heart failure. Combined Cardiorenal Transplant (CCRTx) is indicated in Heart Transplant candidates (HTxC) with Chronic Kidney Disease (CKD). According to the latest update of the International Society for Heart & Lung Transplantation 2016 guidelines (ISHLT), the cut-off value for estimated Glomerular Filtration Rate (eGFR) is below 35 ml/min/1.73 m2 or equal. In our Institution, the cut-off value continues to be less than or equal to 40 ml/min/1.73 m2.
Objectives: To evaluate the renal function of native kidneys by radiorenogram in P with CCRTx. Analyze the eGFR cut-off value to define the candidacy for CCRTx.
Materials and methods: Between February 1993 and October 2019, CCRTx patients were evaluated retrospectively. After one year from transplantation, radiorenogram was performed to assess the viability of native kidneys. Patients with CKD Stage V KDIGO 2012 (Kidney Disease Improving Global Outcomes) were excluded.
Results: Out of 587 HTx patients, 27 P (4.6%) received a CRTx. According to the inclusion criteria, 11 P were analyzed. Age 62 year-old (IQR 55-63). Men 10 P (90.9%). Six P (54.5%) had ischemic cardiomyopathy. The prevalence of cardiovascular disease risk factors was: smoking 9 P (81.8%), high blood pressure 7 P (63.6%), dyslipidemia 7 P (63.6%), diabetes 2 P (18.2%). Emergency transplantation 5 P (45.4%); urgency 4 P (36.4%) and elective 2 P (18.2%). All patients received induction treatment with thymoglobulin and continued during follow-up with a triple immunosuppression scheme (calcineurin inhibitors, antiproliferative, and steroids). Minimization with mammalian Target Of Rapamycin (m-TOR) was indicated in 8 P (72.7%). Analysis of radiorenograms showed loss of native kidneys function in 90.9% of CCRTx patients.
Conclusion: The loss of native kidney function evidenced in radiorenograms confirmed the benefit of Combined Cardio Renal Transplant for the majority of recipients selected under our protocol.
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